Critically ill premature infants require multiple blood transfusions during their hospital course. Policies regarding the guidelines for transfusion vary widely throughout North America. In order to track utilization of packed red blood cells, the Department of Pathology, the Department of Pediatrics, and the GCRC have an ongoing project monitoring red blood cell usage in the Neonatal Intensive Care Unit. Data is collected regarding specific criteria for transfusion and the amount of blood transfused. This represents an ongoing quality improvement project at Fletcher Allen Heath Care and in the Departments of Pediatrics and Pathology.